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									        Pain Management


 David Dayya, D.O.,, M.P.H.
   Saint Barnabas Hospital
Department Of Family Practice
    Myths in Pain Management
 Opioid analgesics commonly depress
  respiration.
 Opioid dependence and addiction are
  synonomous.
 Nsaids are safer alternatives to opioids.
 Opioids are a treatment of last resort.
 Pain is overtreated and leads to legal risks.
 Pain is predominantly an objective measure.
           Pain Categories
 Nociceptive Pain         Neuropathic Pain
 Includes                 “Burning, shooting
  Musculoskeletal, Bone     electrical pain”
  Pain, and Visceral
  pain
 Prostaglandin
  mediated
  inflammation
    Cosequences of Untreated
             Pain
 Morbidity including quality of life issues
  (ADL’s, Depression)
 Death
 WHO Analgesic Step Ladder
 Step 1 Nonopioid +/- Adjuvant
 Step 2 Lower potency Opioid + Nonopioid
  +/- Adjuvant
 Step 3 Higher Potency Opioid + Nonopioid
  +/- Adjuvant
Opioid        Dose    Route(s)      Frequency
Morphine SA   30mg    PO            Q4h
              4mg     IV/IM         Q4h
Morphine LA   30mg    PO            Q12h
Oxycodone SA 5mg      PO            Q6h
Oxycodone LA 5mg      PO            Q12h
Hydromorphone 1mg     PO/IV/IM      Q6h
Fentanyl      25mcg   Transdermal   Q72h
Methadone     5mg     PO            Q6h
Hydrocodone
Codeine       200mg
Meperidine    75mg    IV/IM         Q3h
Tramadol      50mg    PO            Q4-6h

								
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